Friday, January 27, 2012

Learning in Action

A few months ago I was in a CVS in center city when a man came charging through door, shouting “I need an AED!!”

The pharmacy employees looked back and forth at each other but no one made any actions. The man became angrily impatient, crying out “Come on, there’s a guy dying out there!!”

Before I had really processed what was going on I had set down my basket and my feet were carrying me out the door. I knew that administering CPR can become very tiring very quickly, and having just completed my Advanced Cardiac Life Support course I was as qualified as anyone to lend a hand.

Out on the street I immediately saw a group of people crowding over a man collapsed on the sidewalk. As I got closer I could tell CPR was underway but it wasn’t until I was standing directly over them that I felt a jolt of fear. Though in the past I had seen patients who were very sick and patients who were already deceased, somehow I had made it through three years of medical school without witnessing someone actively dying. The purple color of his skin was frightening.

He was receiving quality CPR from an incredibly fortuitous group of bystanders: A nurse at a local center city hospital and a soon-to-be internal medicine intern were trading off on chest compressions, while coincidentally one of my classmates, Mike Hoaglin, was keeping his airway open and performing pulse checks. I was impressed with how perfectly coordinated the nurse and (almost) intern’s handoffs were- the chest compressions were flawlessly continuous so that any positive pressure build-up in his circulation was not lost as they traded turns. Despite all this it was very clear that he was dying.

Just then the man who had burst into the CVS ran over to us. Out of breath, he managed to report that he had looked everywhere, and asked all the local restaurants and pharmacies, and he couldn’t find an AED. The ambulance had of course been called first thing, but we couldn’t yet hear sirens, and the purple tone of his skin was becoming a sickening gray.

Suddenly a picture flashed in my head of the wall in the mail room of my apartment building nearby. I knew where there was an AED! I jumped up and sprinted down the street, flew into my building, grabbed the AED off the wall, shouted something to the confused doormen, and returned to the scene.

As I crouched down again and opened the AED box I said, “I’ve never done this ‘for real’ before”. No one else had either. Luckily, it was exactly like it had been in ACLS training, and there were very, very simple instructions so that even if I hadn’t been to class I could have easily done it on my own.

With the power button pressed the box immediately spoke to us. ‘Analyzing rhythm, continue CPR’. It was reassuring to hear its automated voice providing instructions.

A few moments later, it spoke again:

“Shock advised. Stand clear”.

The shock sent a jolt through his entire body with enough force to raise his head and send it falling back down onto the concrete sidewalk with a thud. I winced but the AED was unperturbed.

“Continue CPR two minutes”.

Chest compressions were resumed, and before the two minutes had elapsed when it would have been time for another shock, if necessary, the ambulance came screeching down the street. As the paramedics loaded the man into the van Mike said he may have felt a faint pulse after the first shock. I wasn’t so sure.

I headed home knowing we had done our best, and wondering if I would ever find out how the man had fared…

The paramedics contacted Mike the day after to thank us for performing excellent bystander CPR, but they didn’t know the condition of the patient, so it was of little satisfaction.

However, a few weeks later, I received a letter in the mail. It was from the man. He had survived, and had asked his emergency room doctor for our contact information from the paramedics. The letter was three pages long and told me about his family, his job, and his hobbies. It talked about what it was like for him to wake up in the emergency room, and how he has memories of being ‘zapped’ and of people yelling at him to stay awake. It talked about his plans for the next few years and how he can’t believe his luck to still be alive. He also included a $100 check, which I didn’t cash, but plan to hold on to forever.

This story had the best possible outcome, and I really believe it was the AED that made the difference. Despite getting the highest quality CPR I think that early shock was crucial. So, I’m ending this blog post with a shameless plug:

This week Penn launches an amazing new phone application and they are kicking it off with a competition. Using your cell phone, you take a picture of each AED you see around the city. The grand prize for the most AEDs photographed is $10,000!!!!!! But even better, all the pictures you take will be used to create an application that will map the location of AEDs all over the city. Then the next time someone needs to find one, they won’t waste time checking pharmacies and restaurants that don’t have them- they can take out their phone and go directly to the nearest place. What a great idea!!